Healthcare: From a Business Analyst's Perspective

January 11, 2021

Health care system is very crucial in any country and this is not something that can be accessible as a single system point of view; it is basically divided into categories depending upon the type of consumers and categorized into public and private health insurance. Speaking of which all Americans are covered by both private and public health insurance but the point to be noted is that most of them have private insurance; the major reason behind this is most of the members have insurance premium through their employers. Government does support medical care in every country but again every individual has his or her preference. In some countries, getting through a government medical care, finding an appointment for a consultation or a surgery at the stage of emergency is not really feasible at times. Having that said only 30 percent of the United States population is covered by public insurance programs such as Medicare, Medicaid and other programs that include children’s health care as well.

Speaking about Medicare, the federal government operates this and this health care system mainly addresses senior citizens especially from 65 and older. On the other hand, Medicaid health care is based on the states insurance program and this mainly serves the people who are below the minimum income occupational line. Children’s health care system also called as CHIP was signed by President Barrack Obama in the year 2009. As a start, this program had a great funding and also good benefits for children health as a plan of initiative this land was set to protect children and the statistics indicate that more than 43 million children have been covered with this health care system.

Speaking of the current scenario about 74 percent of the population in the states is mainly covered by private health insurance. There are plenty of companies that provide health care privately; they have their set of principles and every premium differs based on the company, and the regulations of these policies are set by the State insurance commissioners. These days self-insuring has also become a trend rather than depending on an employer.

Quality of care also matters and there cannot be any kind of excuse for a delay so the hospitals and the insurance system have to come to point of understating on human grounds and try to address the medical issues and emergencies, and make arrangements for member’s access. By improving the quality of health care, members develop trust in the policies, systems and processes, understand the situation and will thereby reduce the risk factor.

The unexpected trauma of COVID-19 has basically triggered every individual’s life routine such as employment and their wellbeing. Many people lost their jobs due to the pandemic and this made them loose their health coverage insurance through their employer, loosing jobs has resulted in people being uninsured and struggling to meet their medical bills. On the other hand, though some of them had jobs they found their coverage dropping due to numerous reasons like cost cutting, and financial crisis of the company itself. Nearly 14 states have taken a decision on not to expand the Medicaid system.

Now we all accept the truth that Medicines is medicine, no matter how and where it’s practiced and this pandemic has unfolded that health care services are being delivered at the locations which were used (or) reserved for other purposes. We all witnessed that parks, convention centers, stadiums, trains and parking lots have become filed hospitals and diagnostic centers. Even nations armed forces has come up with the strategy and plans in converting hotels and dormitories in to hospitals. Most importantly, caregivers have routinely become the only people who can hold the hand of a sick or dying patient since family members are forced to remain separate from their loved ones at their time of greatest need.

During this pandemic crisis, US healthcare regulations which are constrained has been eased by keeping spread of Covid-19. Being said that, Center for Medicare & Medicaid Services has increased its limited ability and expanded their services by offering telemedicine services and paying providers for these services and increased its coverage for such services. This move has boosted the energy of telemedicine providers. Before pandemic the use of telemedicine was very limited due to more regulatory restrictions on reimbursement of payments and quality. The current crisis has exposed yet another inadequacy of our current system of health insurance. It is built on the assumption that, at any given time, a limited and predictable portion of the population will need a relatively known mix of health care services. Predicting health care needs is thus assumed to be a stable and straightforward actuarial exercise. Our health insurance model is not built to cover health care spending during a novel, mass pandemic, when patients with urgent needs descend upon providers at unprecedented rates.

It could have been great if the scenario were quickly identified in the initial stages; that way measures could have been taken early to control the spread of the COVID-19. Government in every country is taking measures and implementing necessary policies aiming at reducing the impact but considering the number of cases and the severity of the situation there is definitely a huge impact on the country’s healthcare system and economy. This may need a reform to certain medical regulations and policies, in order to accommodate and serve a large group of people than now. It is important that along with the governments, health care organizations should also make an effort to educate people with alternative insurance programs to support in this pandemic, particularly when it has affected the economy and unemployment rate.